1983, 03-01 Permit: 83A-1399 Plumbing FixturesPLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
/0g06 -D$ c if 04ost4
SUBDIVISION
LOT
BLOCK
3.
4.
OWNER
tae (-FLA a-213
ADDRESS
CONTRACTOR
PHONE
ZI P
PHONE
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER /S
Actual Set Backs in Feet
North (South [East 'West
Zone Classification
Size of Parcel
ADDR S
7o3 ET rsk
Type Const. ( Occupancy
Sprinklered
❑Yes No ❑ Req'd.
DESIGNER
ADDRESS
6.
CHANGE OF USE FROM
TO
PHONE
ZIP
Valuation
Building Area in Sq. Ft.
Main Floor I Upper Floors 1 Garage Area
Area of Decks
Storage
Finished Basement Unfin. Basement
TYPE
7. OF
WORK
Fr-NEW ❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE,
❑ BLD. ®.PLMB. ❑ MECH. ❑ M.H. ❑ POOL
❑ OTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd. Rec'd.
DESCRIBE WORK
VALUATION — SOURCE
OF
9. UTILITIES
GAS
ELECTRIC
WATER
Enum. Dist. 'Location (Area)
SEWER
Ownership
Public ❑ Private ❑
USE CODE
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law reg - ' g construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTION
DATE OF APPLICATION g'1-13"3 SIGNATURE OF APPLICANT
SPECIAL APPROVALS
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examine
SEPA Checklist
SPECIAL CONDITIONS:
/ i f
6 Roe.. rf
a2 avksNs 1
PERMIT IS NONTRANSFERABLE
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
ryJ
$
PERMIT NUMBER
A
03 *I *8500
*85006
A *0.00 8
139.82
03 -01 -83
2 6.479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
� a.
0f ' 0 T— e3
DATE ISSUED
139.95 *85,002
PERMIT NO. TOTAL